Tata Memorial Centre, Mumbai; India

by Suresh Advani; Chief, Dept of Medical Oncology

TMC is the largest comprehensive cancer centre in the subcontinent. Nearly 650 new cases of children with cancer and at least 18,000 adults with cancer are seen every year. More than 75% of the patients are treated for free or at a nominal charge.

The credit for developing oncology in India is due to the House of Tata's, one of the leading industrial families of India. They established the Tata Memorial Hospital (TMH) in memory of Lady Meherbai Tata, the first lady of the House of Tata's, who died of leukemia in 1932 after treatment abroad. The hospital, the first cancer facility in the country, was opened on Feb 28,1941. As the activities of the hospital grew, it was handed over to the government, and since 1962 has been operated by the Department of Atomic Energy. In addition to the hospital, the government established in 1952 what is now the Cancer Research Institute (CRI). The hospital and the Institute were merged in 1966 under the flag of Tata Memorial Centre (TMC). For more than half a century, the TMC has been at the forefront in the fight against cancer in India.

The Problem
India faces 2.5 million cases of cancer at any given time. The most commonly encountered cases are those related to tobacco use in men, i.e., cancer in the head and neck region, lung and esophagus. In women, the most common cancers are cervical, breast, oral cavity, esophagus and stomach. Since most of these cancers are related to lifestyle, many are amenable to both primary and secondary prevention. The high cancer toll in developing countries like India is attributed to late detection (70% of all cases). Also, there are very few comprehensive cancer centres with good infrastructure.

Facilities
The medical oncology department is the largest in the country; here thousands of patients are treated each year. We see and treat the largest number of leukemic (both myeloid and lymphoid) patients in the country. The department also has a six-bedded bone marrow transplant unit where approximately 30 transplants are performed every year. The medical oncology department has its own hematology laboratory (with automated cell counters, flow cytometers, etc.), cytogenetic laboratory, and molecular biology laboratory.

Most remarkable, however, may be that TMH is the first hospital in the country to introduce joint clinics. Here, the onco-surgeon, medical oncologist, and radiotherapist meet with the pathologist, radiologist and molecular biologist to discuss each patient, after which detailed management is planned. In addition to lymphoma and cervical cancer joint clinics, we have joint clinics for breast cancer, ovarian cancer, head and neck cancer, retinoblastoma and other pediatric solid tumors.

Academic Program
There are about 400 students undergoing training every year in medical and non-medical fields, and over 200 professionals obtain short-term training. TMC is a recognized center for post-graduate training in the fields of medical, surgical and radiation oncology as well as a center for obtaining Ph.D.'s in various specialties. About 70 faculty members are recognized as supervisors in the University for Ph.D. work. TMC also imparts master's degrees in oncological nursing.

Research
The Cancer Research Institute activities cover a wide spectrum and include areas such as lifestyles in relation to cancer patterns, environmental carcinogens (both chemical and viral), cancer immunology and cell and molecular biology. There are groups working on the development of new laboratory models for human cancers. Clinical research is conducted, using a multi-disciplinary approach, in collaboration with clinicians at the TMH, mainly in cancers prevalent in India. The Institute has achieved national distinction as the first to develop transgenic mice, carry out research in human gene therapy and develop an indigenous diagnostic kit to detect HIV infection. Along with basic and laboratory research, clinical research is also carried out in the fields of radiation, surgical and medical oncology either through institutional trials or in collaboration with national and international groups.

Community Outreach
Education and prevention are vital weapons against cancer. Thus TMH has paid particular attention to preventive oncology, with very satisfying gains. More than 7,000 patients have been evaluated and thousands more reached through presentations in schools, public places, radio, etc. The Bill and Melinda Gates Foundation, through the International Agency for Research on Cancer (IARC) of WHO, is helping to fund a collaborative project on cervical cancer prevention with the rural cancer project of TMH at Barshi, a village in the state of Maharashtra.

Whenever help is required to start a cancer hospital or a cancer wing in a general hospital, TMC plays its appropriate role in providing the know-how. TMH has always felt that it should act as a catalyst rather than as a magnet. The hospital has therefore always placed emphasis on training doctors from other regions, so that they can return to their own areas with new skill and knowledge.

International Collaboration
TMC has received international acclaim as a center of excellence in cancer research and treatment. There have been several important international collaborations. Studies are being conducted in collaboration with the National Cancer Institute (NCI), USA and INCTR for treatment of childhood acute lymphoblastic leukemia (ALL) and non-Hodgkin's lymphoma. Collaboration was established with the International Agency for Research in Cancer (IARC), France regarding epidemiological studies for neoplasms of the lung, lymphatic and haematopoetic system. A large cohort study to detect early cancers in women is supported by the National Institutes of Health (NIH), USA. TMC is an active member of the INCTR, through which it helps develop protocols for the treatment of childhood cancers like retinoblastoma, osteogenic sarcoma and acute lymphoblastic leukemia.

Looking Into the Future
To meet the challenges of the next century, various facilities in the hospital were recently upgraded and state-of-the-art equipment was commissioned. This includes MRI, new X-ray machines, a mammography unit, color doppler, a Clinac 2100 C/D linear accelerator with stereotactic radiosurgery and radiography facilities. Through a Computerized Management Information System and complete networking, on-line transactions are being made for patient administration, materials management and other similar activities. With the installation of a hydroclave waste management facility in 1999, TMC was well ahead of the rest of the country in fulfilling its obligation to protect the environment.

The Clinical Research Secretariat along with the state-of-the-art Digital Library has been established to provide the necessary infrastructure and crucial technical support to cultivate a research environment. The hospital with its Scientific Review Committee, Ethics Committee and Data Monitoring and Safety Committee is committed to maintain the highest scientific and ethical standards in medical research and treatment.

As we enter the 21st century and our 60-year anniversary, the fight against cancer will go on.